Provider Demographics
NPI:1962727867
Name:JEBAMONI AMBROSE M.D.P.A.
Entity type:Organization
Organization Name:JEBAMONI AMBROSE M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEBAMONI
Authorized Official - Middle Name:
Authorized Official - Last Name:AMBROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-874-4422
Mailing Address - Street 1:245 ROUTE 206
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4139
Mailing Address - Country:US
Mailing Address - Phone:908-874-4422
Mailing Address - Fax:908-874-8077
Practice Address - Street 1:245 ROUTE 206
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4139
Practice Address - Country:US
Practice Address - Phone:908-874-4422
Practice Address - Fax:908-874-8077
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEBAMONI AMBROSE M.D.P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25573207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2731100Medicaid
NJAM451875Medicare PIN
NJ2731100Medicaid